Less is More
The Globe and Mail recently quoted Dr Jeff Turnbull, former president of the Canadian Medical Association saying that “hospitals need to disappear.” In the same article, Dr Rick Glazier, a scientist with the Institute of Clinical Evaluative Sciences says “we are in need of a truly integrated system.” In the article, several healthcare leaders describe community focused initiatives that can improve the health of individuals and populations. A generative message from the article is that great things are happening that will improve our healthcare system. That point’s lost when the author engages these system leaders in a straw man fallacy.
The sweeping statement that hospitals need to disappear is conflated with the truism that our healthcare system needs better integration. Integration has already become a major theme for hospitals. In my own backyard, CAMH has partnered with housing providers to discharge nearly 100 patients to supportive environments. We’ve marshalled hospital, community and social resources to support community living for people with complex mental illness. An initiative called SCOPE (Seamless Care Optimizing the Patient Experience) brings together expertise from hospitals (UHN’s Toronto Western and Women’s College), the Toronto Central Community Care Access Centre and local family physicians. The SCOPE project supports primary care providers in the care of patients most at risk for repeat hospitalizations and emergency visits.
Most hospitals are physically situated in communities and many provide efficient, conveniently located health promotion, primary care and social supports. Many healthcare activities we believed could only happen in hospitals are now safely provided in communities because of advances in technology and specialized skilling of healthcare workers. Examples of system integration activities exist across all aspects of Ontario healthcare. The work challenges barriers to integration– anachronistic funding models, outdated constructs of professional hierarchy, neglect of social determinants of health, lack of consensus on evidence, questionable indicators of success and incomplete accountability structures.
There are intelligent and well intentioned individuals and groups who have been thinking about this for decades – including those featured in the Globe article. Setting up a competition amongst the various system players isn’t the way to advance a worthy vision. Many of us working in healthcare today are driven to create something better than we have. We’re working to blur the boundaries amongst the components of our system, rigorously evaluating and directing our efforts to provide coordinated care and supports for those most in need. Some of us actually believe that this is what we were born to do.